For Roma activist Jeno Setet, the third wave of the Covid-19 pandemic in Hungary has been an “endless wave of sorrow”. The central European nation’s coronavirus mortality rate is one of the highest in the world and has disproportionately affected his already embattled community.

At more than 6m people spread across the continent, Roma are Europe’s largest minority. Low vaccination rates reflect both lack of access to healthcare and longstanding suspicion of the authorities.

“Roma people do not trust the governments for a good reason,” said Zeljko Jovanovic, director of Open Society Foundation’s Roma Initiatives Office. “They have been disenfranchised for decades, even before the Covid-19 crisis spread through the settlements.”

The plight of Hungary’s Roma highlights a wider problem of vaccine access for Europe’s marginalised groups even as the EU’s immunisation drive gathers pace. Other vulnerable communities who risk falling through the cracks include millions of migrants and homeless people, who face obstacles including discrimination, fear of officialdom and lack of formal paperwork.

The difficulties raise practical and moral questions for European governments and EU authorities, especially given the ease of cross-border travel within the bloc. If vulnerable socio-economic groups are systematically underserved for vaccines, it not only threatens their own health buts national efforts to quell the pandemic.

Anna Vallianatou, a researcher at the Chatham House think-tank, said the EU’s goal of inoculating 70 per cent of all adults by the summer could not be guaranteed if it did not include undocumented people. “This is a public health concern first and foremost, but the deafening silence from politicians and authorities is partly linked to hostile migration policies in Europe,” she said.

Marginalised groups face difficulties even in countries that have committed to making vaccines available to them, with misinformation about the jabs, fear of deportation and difficulties in arranging appointments hampering efforts, experts say.

“There’s a spectrum of realities and there’s a spectrum of approaches and barriers — even in countries where it’s very positive in terms of the inclusiveness of the strategy on paper,” said Alyna Smith, a senior advocacy officer at Picum, a Brussels-based organisation that campaigns for the rights of undocumented migrants.

The importance of evenly spread vaccination coverage across the EU’s 450m population has grown as the bloc’s initially sluggish programme has picked up speed in the past month. Its 27 countries have administered an average of 30.4 doses per 100 residents, according to data gathered by the Financial Times. An estimated 5m undocumented migrants are among Europe’s “shadow population”.

Poland is the only EU country that has explicitly excluded foreigners with no legal residency from its inoculation drive. Governments in France, Spain, Italy and the Netherlands — as well as non-EU nation the UK — are among those pledging to include undocumented migrants in their vaccine programmes. Slovakia has said it will also target its half a million Roma population as an at-risk group.

But prioritising such groups remains logistically difficult, experts say. It largely relies on outreach from civil society and charity groups to find and encourage people to get vaccinated. Many migrants have no legal status to remain in their EU countries of residence and — like Roma — are often not registered with healthcare authorities that open access to jabs through phone, online or in-person booking.

Some European nations have tried to work around the strictures. In Ireland, people without formal healthcare numbers can register for vaccines as long as they have a proof of address. The UK has run so-called “vaccine amnesties” where undocumented migrants are guaranteed access to jabs even if they have no legal documents But observers note people may still be deterred for fear they will be targeted by immigration authorities.

Roma family in Hungary

Countries such as Spain and Italy have shown “political will” for universal vaccination but have fallen short because of “significant design flaws in the registration process”, such as the requirement for health card numbers, said Belkis Wille, a senior researcher at Human Rights Watch.

“The pandemic has exposed in real technicolour all the gaps in society,” said Wille. “Specifically, it has exposed the gaps in healthcare systems — and in particular who is denied access.”

Vaccine hesitancy because of misinformation or mistrust is also an issue. Roma children in 12 central and south-eastern European countries were between 30 and 45 per cent less likely to be vaccinated for a range of diseases, compared with non-Roma children, according to a 2016 study.

A further obstacle for communities such as Hungary’s Roma is a national vaccine rollout led by general practitioners, many of whom are located far from vulnerable groups. “Many Roma are receiving contradictory information: they are told to stay home and not go anywhere, but they are also told to get a vaccine,” said Setet, the Roma activist.

A Hungarian government spokesperson told the FT vaccines were available to “citizens and legal residents”. It declined to say whether outreach to the Roma community — who make up nine per cent of Hungary’s population — was planned.

Helena Dalli, EU commissioner for equality, said EU governments “have the responsibility to provide extra attention to at-risk groups and individuals”, including those “marginalised because of discrimination against their personal characteristics”.

But Brussels was unable to point to specific studies or guidance it had published on how vaccination programmes should do so. The European Commission has published recommendations that highlight refugees as a priority but make no mention of Roma or people without formal documentation.

Calls are growing for Brussels to put public pressure on EU member states to get vaccines to people who risk slipping through the system.

“The commission has been vocal on vaccine equity between states outside the EU but has been basically silent on what equity means within,” said Wille. “If you have pockets of people who are not able to register and get vaccines, that’s not good for anyone — particularly in a union that allows free movement between states.”